Relationships between renin, aldosterone, blood pressure and renal function in hypertensive insulin-dependent...

A cross-sectional analysis of associations between total plasma renin (TPR) and aldosterone, blood pressure, renal haemodynamics, autonomic function and electrolyte balance was carried out in 35 hypertensive non-azotaemic insulin-dependent diabetics. Supine TPR was increased in 10 subjects and reduced in one, although erect TPR was increased in nine but reduced in 18 subjects. The supine to erect TPR gradient was greater than 40% in all cases. Supine and erect TPR correlated closely (r = 0.99, P less than 0.001). No correlation was found between TPR and age or blood pressure and multiple regression analysis failed to reveal independent predictors for TPR. Supine aldosterone was reduced in two subjects and increased in three, and erect aldosterone levels were reduced in three but increased in eight subjects. However, the postural aldosterone gradient was greater than 40% in only 20 cases. Supine and erect aldosterone correlated with each other (rs = 0.64, P = 0.001) but not with TPR. Aldosterone levels were most strongly related inversely to duration of diabetes, diabetic retinopathy, parasympathetic neuropathy and directly to diastolic blood pressure and glomerular filtration rate. Aldosterone levels correlated negatively with age. This was corrected for in multiple regression analysis which revealed an inverse relationship between supine aldosterone and serum potassium (P less than 0.05) and a direct one with renal plasma flow (P less than 0.007). Erect aldosterone was independently associated with duration of diabetes (P less than 0.005), systolic postural gradient (P less than 0.02), and the postural aldosterone gradient with the presence of parasympathetic neuropathy (P less than 0.004). The observation of elevated TPR in 10 subjects and the lack of relationship between TPR and other variables may reflect the overproduction of inactive relative to active renin in insulin-dependent hypertensive diabetics with autonomic dysfunction. The association between aldosterone and blood pressure, renal haemodynamics and electrolyte balance suggests that mineralocorticoids may be relevant to the natural history of hypertensive diabetic renal disease.